Highly sensitive psychotherapists are, of course, good at what they do. But as in all situations with HSPs, they have to be careful that they and others do not “kill the goose that lays the golden eggs.” You have to take care of yourself more than other therapists.
Here are some thoughts from my own experience. Yours of course will be different, so adapt this to your needs, but these are some ways you might practice the all-essential self-care:
- Practice what we now can call “The Five Necessities,” from the Introduction of the first book (and mention them to HS clients, too):
A. Believe your trait is real—review the research if you doubt it.
B. Reframe your childhood in light of the trait.
C. Heal from past wounds, since HSPs are differentially susceptible (affected more by both good and bad environments, in childhood or now).
D. Don’t try to live like the other 80% (including the majority of therapists).
E. Be with a group of other HSPs at least once, to see how different we are. Try to have some HS friends, if you have time in your life.
- Reduce therapy work time. I doubt it is very good when any therapist works more than 20 hours a week, but certainly not highly sensitive therapists. We simply are not giving our best after that. You may want to work four days a week and then be able to take three days off for a long weekend. Or whatever arrangement works for you. If you need to make more money, there might be other things you could do part time as long as they’re not too demanding. An introvert might work on writing a book, editing, working with animals or in nature in some way, doing a craft that can be sold, or cooking in some way that makes you some money. (But not high pressure catering—nothing high pressure). Extroverts might be okay with a non-clinical group or a part time sales job, selling something that you believe in and in an atmosphere without pressure.
- Screen patients. It is very important that you screen your patients and not take the most difficult ones. The screening should be done in a phone conversation, so that they don’t form an attachment after even one session. When you begin, say that you may not be able to take the person, and the interview will help you decide. Give a reason ahead of time that you can fall back on so that it does not seem that you are rejecting them personally. Maybe you are not sure you have time in your practice. And that’s the truth because you don’t have time in your practice for very difficult people. I also think it’s important to really like the potential patient, but I have been charmed at the start by people who turned out to be extremely difficult, so “like” is different from “charmed.”You will want to know the potential patient’s presenting issue, of course, but mainly a very brief history. (If the person cannot comply with a reasonably a brief history, this could be a red flag in itself.) You know the signs of someone who will be difficult. There will be a description of child abuse or incest, or very serious attachment issues from early childhood, such as parents having been through some horror, such as the Holocaust, or a caregiver abandoning the family or suffering from depression, drug abuse, a terminal illness, etcetera. These are people who almost surely have deep troubles. You can always refer them people to therapists who really like challenges (many do–learn who they are).Finally, be sure the person has the financial resources (cash or insurance) to pay for therapy at your regular fee for as long as you estimate they will need your services. Be frank about this.
- Downtime. All HSPs—and that means you–must have plenty of downtime to avoid nasty consequences, such as serious errors, illness, depression, or ruining an important relationship. Ideally some of this will be right after you finish seeing patients, maybe near your office but not in it. If you have family that you’re going to be with, have them understand that before you join them you need this time, perhaps to lie down, meditate, or walk by yourself. You also need to limit your social life, especially if you have a family or are an introvert. Even supportive people add to your day’s stimulation load.
- Don’t take your work home. I don’t know why I was able to separate myself from my patients psychologically, but I usually could. It may have been the careful screening I learned to do, because I did have some difficult patients at first who were with me mentally all the time. So perhaps this is about screening. Also, do not take them home literally: Take all your notes between clients. Space them out so that you can do this. You don’t want to be taking notes at home. Same with insurance. You don’t want a lot of paper work. Try to avoid insurance situations where you have to fill out forms and if possible don’t be on panels. And this brings up the issue of money.
- Charge clients appropriately—that is, charge enough! That is, charge what they can pay for something very important to their lives. For some it will be as important as a college education. This is not the time for empathy to get in the way, because you need to have your boundaries, and to role model them to clients. Ethically, this is the only way you can do a good job with everyone.It may help to develop a specialty that others in your area do not offer and focus less on those offered by everyone. For example, few therapists seem to teach parents about their children’s temperaments (all varieties of temperament that affect behavior). Indeed, there are other temperaments besides HS in adults (see Evans and Rothbart’s Adult Temperament Questionnaire; https://www.b-di.com/atqweb.html; nothing like the Myers Briggs) and also rarely know about these. Just some ideas.
- Find a Good Consultant. Be worth what you charge. I believe it’s important to have a good consultant. It may not be necessary to go weekly as long as you have someone you can contact by phone if necessary and hear back in 24 hours. I think private consultation works better than group consultation, which can be quite tiring and fail to meet your needs. Maybe a consult group is not tiring for an extrovert, but I think often it will be. Hearing about other patients can be quite intense, especially the ones that therapists bring in to talk about. So what you need is a consultant who is the best therapist you know of. This is so important, because you can put the difficulties on that person’s shoulders for a while, and think through together what needs to be done next.Your consultant should be someone who is kind and sensitive, even if not highly sensitive (Indeed maybe it is just as well if they are not as long as they thoroughly understand it.) You should never walk out of a consultant’s office feeling bad about yourself. You should either feel that you learned something or you were already doing the right thing. Sometimes people can be very brusque even when they’re kind and wise. They just use a non-HSP’s volume, asking questions like, “Why in the world did you do that?” Or “What were you thinking?” You just don’t need that in a consultant.
- Seek Out Your Own Therapist. I also think most if not all therapist should be in therapy themselves. Again, even if this is expensive, it helps make you worth your fees. There are so many reasons for this I won’t go into them. If you have been in therapy a long time it might be okay not to continue. But ideally you could go back if something came up.
- Take Frequent Vacations. Especially if you have some separation or attachment issues, you can really be hooked by your patients having the same issues. You may feel it’s terribly cruel to take off more than two weeks a year besides holidays. You probably should take more. As my own consultant told me, by doing this you are role modeling good boundaries. Further, you would not be the good therapist you are (highly sensitive) if you were not someone who needs extra time off! Finally, they do need to get used to not having you, as that could happen any time. When you are screening people, you can warn them at the beginning that you take off several months a year. If they can’t handle that, or you suspect they can’t given their backgrounds, then it is very important to refer them, and now you have a good reason to do that.
Again, some of the above may mean a drop in income, at least in the short run, but this is your life we are talking about.